Sign On | Medicare Coverage of Hep B Screening

The following is a call to action from Hep B United, NVHR, the Hepatitis B Foundation, the National Task Force on Hepatitis B and others who have composed an organizational sign-on letter requesting initiation of National Coverage Determination process for including Hep B screening as a free Medicare preventative service.

To sign the letter, please send the name of your organization, city, and state to info@nvhr.org. Please note this letter is for organizations only. The deadline to sign the letter is 5 pm Eastern, Monday, May 18, 2015.


Last year, the United States Preventive Services Task Force (USPSTF) revised its hepatitis B screening recommendations and gave a “B” grade (recommended) to testing those at high risk for hepatitis B infection. Under the Affordable Care Act, any preventive service with an “A” or “B” grade must be provided by Medicare at no charge if CMS decides to include the service as a benefit. To add a service, CMS must undergo a NCD process, in which it reviews evidence and makes a decision on whether or not to provide the service.

The first part of the NCD process is a formal request to CMS from the community. Below is an organizational sign-on letter that urges CMS to begin this process. We hope to have a long list of organizations supporting this request.


 

[Text of letter:]

Tamara Syrek Jensen, JD
Director, Coverage and Analysis Group
Center for Clinical Standards and Quality
Centers for Medicare & Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244

RE: A Formal Request for a National Coverage Determination for Screening for Hepatitis B Virus Infection Among High Risk Individuals

 

Dear Ms. Jensen:

The undersigned organizations are writing with a formal request for a Medicare National Coverage Determination (NCD) for Screening for Hepatitis B Virus (HBV) Infection.

Specifically, we ask that the Centers for Medicare & Medicaid Services (CMS) provide hepatitis B screening coverage for Medicare beneficiaries who are at high risk for HBV infection as defined by the United States Preventive Services Task Force (USPTF), including those born in countries and regions with a high prevalence of HBV infection (>2%); people born in the United States who were not vaccinated as infants and whose parents were born in a region with a very high prevalence of hepatitis B infection (>8%), such as sub-Saharan Africa, and southeast and central Asia; HIV-positive individuals;  injection drug users; men who have sex with men and household partners and sexual partners of people who are HBV infected.

An estimated 700,000 to 2.2 million people in the United States have chronic HBV infection, according to sources cited in the USPSTF’s recommendation statement. Alarmingly, an estimated 67% are unaware of their chronic HBV infection, placing them at significant risk for advanced liver disease, liver cancer, and/or in need of a liver transplant. HBV is the leading cause of primary liver cancer (hepatocellular carcinoma, HCC), and remains the only cancer that continues to rise rising in both incidence and mortality among men and women in the U.S. Both chronic HBV and HCC disproportionately affect Asians and Pacific Islanders (API), who make up 50% of the HBV infection burden in the U.S., and have liver cancer rates that are up to 13 times higher than Caucasian populations in the U.S. In fact, HCC has recently become the #1 cause of cancer death in Vietnamese men in the U.S.

There are significant barriers to HBV screening in the U.S., including the silent nature of the disease and the lack of HBV screening currently being conducted at the primary care level. Increasing HBV screening is critical to saving lives, as those who are diagnosed can take advantage of lifestyle changes and FDA approved medications that can help prevent end-stage liver disease and liver cancer. In addition, many new treatments are now in development promising a bright future for preventing morbidity and mortality among infected individuals.

Under the authority granted by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS has the authority to cover preventive services that have received an “A” or “B” grade from the USPSTF after a service undergoes an NCD. In May, 2014, the USPSTF updated its HBV screening recommendations and issued a “B” grade for testing those at risk for HBV infection.

The revised USPSTF hepatitis B screening recommendations are a significant advance in efforts to identify those with chronic HBV and link them to care. However, Medicare coverage currently doesn’t include HBV screening for any population. This lack of coverage does not reflect current science or recommendations from the nation’s leading medical and public health experts. We urge CMS to initiate an NCD consideration of hepatitis B screening under the “Preventive and Screening Services” category in light of the new evidence-based recommendations.

Adoption of USPSTF’s revised grade for HBV testing would allow Medicare to play a crucial role in helping to identify those who are unaware they are HBV positive. Of the identified and reported cases of HBV in the U.S. between 2007 and 2012, 15.6% were over the age of 65 and part of the Medicare covered population.  Seniors who are Medicare beneficiaries and are unware of their HBV infection are likely to have been living with the disease for a very long time and it is vital to ensure they are linked to care and treatment before they develop advanced liver disease or liver cancer. Additionally, those with end stage renal disease are at higher risk for HBV infection and are less likely to respond to the HBV vaccine, and would benefit greatly from screening and subsequent linkage to care.

By including the USPSTF hepatitis B screening recommendations under Medicare Preventive Services, CMS would align its policy not only with the science, the Centers for Disease Control and Prevention (CDC) and the USPSTF, but also with the goals of the federal government’s Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis, and would lead to improved health outcomes for Medicare beneficiaries, many of whom face significant disparities in health care.

We appreciate your consideration of this request.

Sincerely:

 

List of organizations in process

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